Kidney Disease in Conflict Settings: Prevalence and Risk Factors Among Syrian Adults Living in North and East Syria

Abstract

Background: Chronic kidney disease (CKD) is a major global public health problem associated with substantial morbidity, mortality, and healthcare costs. In Syria, prolonged conflict has disrupted healthcare services and may have increased exposure to environmental and lifestyle-related risk factors for kidney disease. However, epidemiological data on CKD in Syrian populations remain limited. This study aimed to assess the prevalence of CKD and identify associated risk factors among adults living in North and East Syria. Methods: A cross-sectional study was conducted between December 2023 and June 2024 among 150 adults recruited from outpatient clinics and internal medicine departments in North and East Syria. Sociodemographic characteristics, medical history, lifestyle factors, anthropometric measurements, blood pressure, fasting blood glucose, serum creatinine, and blood urea were assessed. Estimated glomerular filtration rate (eGFR) was calculated using the CKD Epidemiology Collaboration (CKD-EPI) equation. CKD was defined as eGFR <60 mL/min/1.73 m². Associations between CKD and potential risk factors were evaluated using correlation and chi-square analyses. Results: The mean eGFR was 40.4 ± 27.0 mL/min/1.73 m², and 72.67% of participants met the study definition of CKD. Advanced disease stages (CKD stages 3b–5) accounted for a substantial proportion of cases. CKD prevalence increased significantly with age (p < 0.001) and was higher among males than females (p < 0.001). Elevated mean arterial pressure (MAP) (p < 0.001), hyperglycemia (p = 0.009), a history of hypertension (p = 0.004), and cardiovascular disease (p < 0.001) were significantly associated with CKD. eGFR was negatively correlated with MAP (r = −0.263, p = 0.001). Reliance on Euphrates River water (p < 0.001) and long-term analgesic use (p = 0.017) were also significantly associated with CKD. No significant associations were observed for BMI category, smoking status, physical activity, or dietary pattern. Conclusions: A high prevalence of eGFR-defined CKD was observed among adults attending healthcare facilities in North and East Syria. Older age, male sex, elevated blood pressure, hyperglycemia, cardiovascular disease, long-term analgesic use, and reliance on Euphrates River water were associated with CKD. These findings highlight the need for enhanced screening and management of cardiometabolic risk factors and further investigation of environmental determinants of kidney disease in conflict-affected populations.